Provider Demographics
NPI:1437472610
Name:BART J BELCHER DC CSDE LLC
Entity Type:Organization
Organization Name:BART J BELCHER DC CSDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-424-6222
Mailing Address - Street 1:152 ROSWELL ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1945
Mailing Address - Country:US
Mailing Address - Phone:770-424-6222
Mailing Address - Fax:
Practice Address - Street 1:152 ROSWELL ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1945
Practice Address - Country:US
Practice Address - Phone:770-424-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA254765927Medicare UPIN